Provider Demographics
NPI:1275203259
Name:ANDERSON, MORGAN (DDS)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 EASTGATE AVE S
Mailing Address - Street 2:
Mailing Address - City:PACIFIC
Mailing Address - State:WA
Mailing Address - Zip Code:98047-1217
Mailing Address - Country:US
Mailing Address - Phone:253-218-7335
Mailing Address - Fax:
Practice Address - Street 1:1720 2ND ST
Practice Address - Street 2:
Practice Address - City:CHENEY
Practice Address - State:WA
Practice Address - Zip Code:99004-1910
Practice Address - Country:US
Practice Address - Phone:509-444-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE61202738122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist